Photodynamic Therapy for Cholangiocarcinoma

Abstract

Cholangiocarcinoma is the primary malignancy arising from the biliary epithelium, and it presents as jaundice, cholestasis, and cholangitis. Over 50 percent of patients present with advanced-stage disease, and the prognosis is poor with the survival measured in months even after biliary decompression. Palliative management has become the standard of care for unresectable disease, and this involves an endoscopic approach. Photodynamic therapy (PDT) involves the administration of a photosensitizer followed by local irradiation with laser therapy. The use of PDT for palliation of bile-duct tumors has produced promising results. Several studies conducted in Europe and the United States have shown that PDT produces a marked improvement in the symptoms of cholestasis, survival, and quality of life. This chapter summarizes the principle of PDT, the technique employed, and the published experience regarding PDT for cholangiocarcinoma. (Gut Liver 2010;4(Suppl. 1):S62-66)

Biliary Tumor Ablation with Photodynamic Therapy and Radiofrequency Ablation

“…1 Endoscopic retrograde cholangiography is performed using a large-channel duodenoscope. 7 After cannulation into the biliary tract, a cholangiogram is performed to help define the anatomic distribution of malignant tissue. 7 Then, selective bougie and balloon dilation of the stricture(s) to be treated is performed.…”

“…6 For instance, Porfimer sodium (Photofrin; Axcan Pharma Inc, Birmingham, AL), which is the only photosensitizer approved by the Food and Drug Administration (FDA), is injected intravenously at a dosage of 2 mg/kg body weight 48 hours before laser activation. 7 All the procedures are done under general anesthesia. Considerations before ablation therapy include assessing resectability or not, determination of atrophic segments, antibiotic prophylaxis, and patient education (Box 1).…”

Current Status of Endoscopic Treatment of Advanced Hilar Cholangiocarcinoma

“…The laser light sources that deliver the appropriate wavelengths have been used for intraluminal illumination. A power density of 300-400 mW/cm and a power energy of 180-200 J/cm (of the diffuser length) is delivered through the fiber, while the irradiation time is 400-600 s [51]. This leads to 2-6-mm tumor necrosis depth.…”

“…Based on the mechanism that the photosensitizing agent concentrates in the lesion, the photosensitizer is activated by non-thermal laser light of an appropriate wavelength, which leads to subsequent damage of the neoplastic tissue by generated free oxygen radicals [51]. Four photosensitizing agents are currently used for CCA.…”

Single-operator cholangioscopy in biliary disorders: going beyond visualization

“…15 However, even if SOC was incorporated in our arsenal, the supporting personnel still need to be adequately trained, image quality needs to be improved with the adjunct of digitalization, and strict and specific criteria need to be created and standardized to assess biliary lesions with greater accuracy. 16 In terms of intervention, improving the flexibility of the system will facilitate biopsy sampling and widen its therapeutic potential.…”